For a study, researchers sought to identify the nature of the relationships between birth weights and severe postpartum hemorrhage in twin pregnancies.

The JUMODA (JUmeaux Mode d’Accouchement) cohort was a national, prospective, population-based research of twin births carried out in France between February 2014 and March 2015. They did not include individuals with fetal mortality, a medically indicated abortion, an antepartum hemorrhage, a placenta previa, a placental abruption, or an underweight baby. The main consequence was a severe postpartum hemorrhage, which was defined as a postpartum hemorrhage requiring at least one of the following interventions: transfusion of four or more units of red blood cells, uterine artery embolization, uterine balloon tamponade, vascular ligation, uterine suture, emergency hysterectomy, admission to an intensive care unit, or a postpartum hemorrhage deemed severe by the obstetrician or leading to maternal death. The two twins’ combined birth weights made up the exposure. They employed multilevel multivariable modified Poisson regression modeling to examine the relationship between the sum of twin birth weights and severe postpartum hemorrhage. Analysis was done for the entire population and the intended and actual modes of delivery.

Over 8,373 patients in all were examined. Around 4.5% (379/8,372, 95% CI 4.1-5.0) of women experienced severe postpartum hemorrhage, with rates ranging from 2.1% (15/722) for twins with combined birth weights under 3,000 g to 8.8% (12/136) for twins with combined birth weights above 6,500 g. With an adjusted relative risk of severe postpartum hemorrhage of 1.36 (95% CI 1.24-1.49) for every 500-g increase in the sum of the twins’ birth weights, the association between the sum of the twins’ birth weights and severe postpartum hemorrhage was found to be linear in the multivariable analysis.

With the sum of the twins’ birth weights, the risk of severe postpartum hemorrhage increased in twin pregnancies.

Reference: journals.lww.com/greenjournal/Abstract/2022/12000/Risk_of_Severe_Postpartum_Hemorrhage_in_Twin.8.aspx